February 25, 2014

Imagine that you are a second year
pharmacy student enrolled in a pharmacokinetics course. Your professor assigns
readings prior to the class. She then spends the two-hour lecture period with
her back to the class deriving equations. You are dismissed from class with 20
practice problems for homework. The topic seems understandable during class and
you think that your note taking skills are adequate.But when you arrive home and begin working on
the first problem, you soon realize that you understand very little about the
information covered during lecture.Moreover, your notes are incomplete because you could not type or write
as quickly as the teacher was speaking. As you wade through the 20 problems
assigned the homework grows increasingly frustrating.You feel defeated and you decide that
pharmacokinetics just isn’t “your thing.”

How can this scenario be avoided? The
answer may be the flipped classroom. The flipped classroom is a learner-centered
teaching model that reverses or “flips” the order in which learners are exposed
to new material.1 In the model, new course material is covered prior
to class using common instructional methods such as videos, readings, podcasts,
or powerpoint slides with recorded audio. Presenting new material to students
prior to class provides the opportunity for learners to view and review the
material as many time as necessary until it is understood.2 The
scheduled class period is dedicated to hands-on activities requiring higher
levels of cognition (analyzing, evaluating, and creating). Activities may
include discussions, exercises, projects, or cased-based role playing.2
Instructors often use class time to monitor student’s progress, guide them in
their approach to learning, and revise course content based on student
response.

One of the potential advantages of the
flipped classroom is that the model facilitates the implementation of in-class
activities that can appeal to multiple learning styles. During in-class
activities the teacher is better able to spend one-on-one time with each student and
to provide immediate feedback.3 Additionally, providing new course
material in formats that may be viewed more than once can be especially helpful
for students with barriers to learning (English as a second language, attention
deficit disorder, hearing impairment).1 To be successful, students
are required to be self-motivated and active learners.

The flipped classroom is not a new instructional
model as it contains elements similar to the Socratic method (5th
century BC) and has been implemented in traditional undergraduate courses like
physics for decades.4 However, it is a model that gaining more
attention in pharmacy education. Until recently there was little evidence
demonstrating its effectiveness. In 2012, the University of North Carolina
Eshelman School of Pharmacy assessed the effect of implementing a flipped
classroom model in a pharmaceutics course on student academic performance,
engagement, and perception.4 The intervention consisted of pre-class
assignments including readings and pre-recorded video mini-lectures.During each class period, four active
learning exercises were implemented. The effectiveness of the active learning
exercises were assessed using several methods including clicker questions,
think-pair-share, student presentations and quizzes. The assessments allowed
instructors to gauge students’ knowledge in real-time and deliver micro-lectures
(1-3 minutes) to clarify key concepts. Students were also assigned 2 course
projects, given multiple quizzes, a mid-term exam, and a cumulative final exam.
Based on data collected using pre and post course surveys it was determined
that learning foundational content prior to the scheduled class period
significantly enhanced student learning of course material in class (p = 0.001)
and interactive in-class activities significantly enhanced student learning overall
(p = 0.01). After completion of the course, more students indicated that they
preferred the flipped classroom structure over the traditional classroom
structure (p = 0.001). Despite positive outcomes related to student engagement
and perception, student academic performance based on examination scores was
not significantly improved using the flipped classroom model when compared to
the traditional model (p = 0.31).

While there are potential benefits of the
flipped classroom, there are potential pitfalls that educators should be aware.
The first is student workload.4 If careful consideration is not
given to the length of videos or volume of reading required prior to class, students
may become overwhelmed, show up unprepared for class, and unable to engage in the
in-class learning activities. Educators should also consider the time and
effort required to re-design lesson plans to fit the flipped classroom model.5
Educators will need to dedicate more time to evaluating activities and projects
designed to assess student learning. Lastly, educators and students must have
access to certain technology, like high speed Internet.

The flipped classroom method will probably
never eliminate the need for traditional models of teaching but, it is a method
that should be added to the teacher’s repertoire in higher education. When
educators observe that lecture attendance is low, students seem bored during
class, or when course material needs to be refreshed, the flipped classroom may
be an effective strategy for re-engaging learners and teachers alike.

How many times have we lived without knowing what our purpose was? How easy is it to do something when we’re unaware of its importance? At these times we’re like a boat sailing around aimlessly to no end. So how do we get some direction? The Continuing Professional Development (CPD) model2 can help put things into perspective.

The CPD model is a process that can be used to teach learners to
improve any area of their life. There are five stages to this model that are
interconnected: Reflect, Plan, Act, and Evaluate with Record and Review at
the center.

1. Reflect on living
your life for your personal purpose and no one else’s. (Figure out
which port(s) you want to sail to)

Goals derived intrinsically are more likely to be achieved when compared
to extrinsic goals.3 When your goal is actually the goal set by
someone else, intrapersonal conflict can arise, causing resentment and
displeasure in attempting to achieve it.3 Do a self-appraisal of
where you want to be, not where someone else thinks you should be.2

Think about “approach” and “avoidance” goals. (Do you know which ports you want to sail toward and the ones
you don’t?) Approach are prevalent in individualistic
cultures such as the United States (“the West”) and avoidance goals are more common in collectivist cultures such
as Japan (“the East”).4 In the West, goals are focused on desired outcomes
and how to move towards them (approach). In these cultures, each individual is expected
to “stand out” and do their best.4In contrast, in the East, individuals work to
assimilate themselves and embrace unity.4 Thus, goals are based on
what actions should be avoided so as to remain unnoticed.4I am someone who was raised in the West with a
heritage from the East. I believe any changes initially consider to be
avoidance can be easily converted into approach goals. For example, instead of
thinking I should avoid gossip, my goal could be to speak directly to individual
with whom I have conflict.

2. Plan to make your
goals S.M.A.R.T.2(Goals often go unachieved because the boat sails
without a map to a destination port3)

Goals should be:

a.Specific – this
brings forth action towards the dream2

b.Measurable –
without this, how will you know you have grown closer to or reached your goal?2

c.Achievable – with
the limited resources we have, can the dream goal be reached?2

d.Relevant – is the
dream goal pertinent to you and your desired area of life?2

e.Timely – without
this critical piece, a dream goal will continue to be one2

Make separate changes for each important domain you live in. Domains
of life include activities of daily living, professional, financial, social
life, close relationships, physical health, emotions, and spirituality/se­nse
of community.1 For example, in activities of daily living, my
lifestyle changes could be clean dishes after eating, vacuum every week, or
throw away the trash before it piles above the top of the can. Whereas a SMART professional
goal might be to read three articles in professional journals every week.

3. Put plan into
action and avoid feeling happy simply because you accomplished a goal.1,5 (Use
your map, get sailing, and don’t let reaching that port be the end of your sea
adventure)

Typically, goals are based on a hierarchy: at the top of a pyramid are
peak goals – the furthest one can imagin­­­­e oneself from the present state.
In the middle are distant goals that bridge lofty peak goals to task goals – those
things that are accomplished daily to reach the peak goal.6 While a
feeling of accomplishment may be appropriate in certain situations (e.g. completing
a project for a class), it may not create the best mentality.6

In a study by Hadley et al, the investigators discovered
that clinically depressed patients have goals and thoughts about the future; however, they tend to be
conditional.1 Conditional goals predicate individual happiness and self-worth
on goal achievement.Thus mental anguish
can result from attempting to reach the goal through daily tasks.1

Instead, do away with focusing on a goal and instead focus on daily
commitment to change. Eventually, you will surpass that goal without creating
cognitive pressure and anxiety to achieve it.Moreover, you will benefit from the change you’ve adopted.5For example, I want to run at least one
marathon in my lifetime. This requires training by scheduling runs and
increasing slowly until day of the race. After the marathon, I may not feel as
motivated to stay in shape. What if, instead, I set a goal to run five miles
three times weekly and made it a healthy lifestyle habit? In one year, I will
have run nearly 30 marathon-equivalents with no artificial goal “event” that
might trigger me to stop.

4. After every
stage, evaluate how well Reflection, Plan, and Action, was completed. (Constantly evaluate how effectively you are sailing towards your port)

Repeatedly reflect and decide if what you are doing is contributing toward
your goals. If so, give yourself some praise. If not, re-assessment and
re-planning is warranted.2

5. Lastly, Record and Review your progress constantly.(Remember the paths you sailed for
future reference)

This serves as documentation
to help plan future actions.You may
wish to include some of your accomplishments on your curriculum vitae. During
each evaluation step, this can be useful as a guide to help you remember where
you are in reaching your goals. This record must be easy to understand and
up-to-date.2

If you use the CPD cycle wisely, any wind will be favorable because
you know to which port you are sailing, have a plan on how to get there, and will continually evaluate your progress.

by Brittany Palasik,
Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

My
parents are both pharmacists practicing in the state of Maryland.Over the years, I have attended many
continuing education sessions with them.I have snored through most, but was intrigued by some of the topics
discussed.Some pharmacists are so
specialized now, that it seems useless to spend time learning topics that don’t
directly pertain to their specialty. How essential is it to learn topics that
seem unrelated to your scope of practice?

Continuing
education (CE) is required by law for many health professionals.The Accreditation Council for Continuing
Medical Education describes the importance of maintaining knowledge for health
professionals.1Indeed, knowledge
has been moving forward increasingly fast and health professionals need to
continually learn the latest information in science and medicine. However,
many healthcare professionals complain about the extra work required and wonder
if CE is actually beneficial. I decided to investigate the pros and
cons of continuing education.Is it
really necessary?After all, aren’t we
all supposed to be learning on the job every day?

Why Require CE?

Fact:CE has been directly
correlated to positive health outcomes.2

In
a study completed by the American College of Surgeons, continuing education
resulted in reduced morbidity and mortality rates for surgeons performing
segmental colon resections as well as repair of ruptured abdominal aortic
aneurysms.Additionally, rates of
myocardial infarction were lower in cardiologists who had participated in
continuing education, than those who had not.2

Fact:
CE can improve knowledge in the short- and long-term.3

Twenty
eight different studies were examined by the Johns Hopkins Evidence-based
Practice Centre to determine the efficacy of continuing education.Twenty-two (79%) of the studies showed
knowledge improvement, whereas only 4 (14%) of the studies showed no difference
in knowledge (2 studies [7%] had mixed results).These same 28 studies were evaluated through
follow-up and resulted in 15 studies (68%) demonstrated long-term knowledge retention.3

Why shouldn’t we require CE?

Fact:CE programs can be biased.

All
too often health professions will obtain most of continuing education funding
from pharmaceutical companies.This can
introduce bias, as each company can influence the subject matter.Additionally, this can reduce the
availability of content that may be relevant for contemporary practice but
which is not within the business interests of the sponsor.2 For
example, a new guideline that is important for the healthcare community may not
be promoted through continuing education because the guideline does not favor
the use of more expensive brand-name products.

Fact:CE is time-consuming.

In
Maryland, 30 hours of approved continuing education must be completed by
pharmacists within 2 years in order to renew licensure.Two of these hours must be live sessions.4
Some pharmacists complain that 30 hours is a large amount of time to dedicate
to continuing education.Some
pharmacists and other healthcare professionals believe that they learn every
day through their work activities and this extra work should not be required.

For
those who believe CE should be required, the evidence suggests, that under
optimal conditions, continuing education is beneficial.3 But CE
isn’t without problems.Its potentially
biased and requires an investment of time and money. I think we can all agree
that poorly designed instruction that’s not engaging or relevant to the
audience is unlikely to lead to improvements in practice or patient care
outcomes.How can we ensure that
healthcare professionals are getting a snooze-free, informative, knowledge
refresher that improves their skills and the care of patients?

How can we improve
CE?

A
systematic review completed evaluated different forms of educational techniques
including live sessions, computer-based instruction (off-line and online
real-time), videos, audio recordings, handheld materials such as laminated
cards, and printed documents (articles and monograph).3Simulations and other interactive lessons,
whether online or in person, were the most effective.There was no differences found in any of the
other instructional techniques when used alone. However, there was a significant
difference when instructional techniques were combined.So, by combining different techniques such as
videos, hand-outs, and live simulations, continuing education can produce
significant improvements in healthcare practitioner knowledge and skills.It was also shown that repetition led to
improvements in short and long-term knowledgeretention.

There
are many recommendations to reduce the potential bias due to
commercialism.Increasing awareness
among healthcare providers regarding the potential bias within continuing
education programming seems to be the best first step.By revealing the possibility for bias,
professionals may be more apt to critically evaluate continuing education
programs.Other suggestions include
requirements mandated by the Accreditation Council for Continuing Medical
Education (ACCME):5

1.
Compiling a list of (that year’s) most important topics

2.
Requiring proper disclosure of amounts received for funding

3.
Limiting the amount of funding received from commercial entities or completely
removing commercial funding.

Lastly,
there has been a lot of hype about implementing the Continuous Professional
Development (CPD) Model.The CPD differs
from traditional CE in that it incorporates practice-based learning.The goal is to improve performance of
healthcare providers and to individualize objectives for a particular person or
organization.6

The CPD cycle (Figure 1) begins
with self-appraisal: the individual reflects upon his or her own experiences, strengths,
and weaknesses.Then the individual
creates a personalized learning plan, implements it (with documentation of
course!), and evaluates the efficacy of what’s been learned.The circle metaphorically represents the
never-ending cycle of knowledge and skill development in healthcare.As healthcare professionals, we have to continually
learn new advances and skills if we want to make a positive impact in patients’
lives.6

Facebook, Twitter, Pinterest, YouTube, Instagram, LinkedIn … the list
goes on and on. Social media has an increasing presence in our society and
professional students are not immune to this cultural shift towards information
sharing and social openness. As the social media and online forums grow, health
professionals and students have more opportunities to interact with colleagues,
patients, and faculty online — whether it is via email, social networking,
blogging, or tweeting. My personal experience with social media began as an
undergraduate student when Facebook was first emerging, continued through pharmacy
school, and into my residency training. As a professional student, I can
remember wondering if social networking websites were appropriate, whether I
needed to change my profile when applying to post-graduate residency programs,
where the line between my personal and professional life existed online, and
how I was representing myself and my profession via social media. Professional
students and faculty must make decisions regarding online social media
resources and online communication etiquette; decisions that could potentially
impact their careers.

Professionalism in the online domain, or e-professionalism, has become
a significant issue in health professions education as well as practice. One of
the goals of professional education is to instill values and a sense of responsibility
in students. E-professionalism is no
less crucial than more traditional forms of professionalism and should be taught
in the professional curriculum. E-professionalism has been defined by Cain and
Romanelli as “the attitudes and behaviors (some of which may occur in private
settings) reflecting traditional professionalism paradigms that are manifested
through digital media.”1 E-professionalism not only encompasses
professional behavior on social networking sites but also proper online
communication etiquette, also termed “netiquette.” Netiquette includes using
appropriate terms and tone when writing emails or posting on online discussion
boards.1

Through the use of social media sources, a professional student creates
an “online persona” based on choice of photographs, group affiliations, posts,
and comments.1 Students digress from professional norms when they
post derogatory comments about their educational institution, post pictures of
drug or alcohol abuse, affiliate with groups that are disrespectful of certain races
or sexualities, and post private patient information on public domains.1

Many health care institutions including The Ohio State University Medical
Center, Mayo Clinic, and University of Maryland are now instituting policies
with guidelines regarding use of social networking by employees in order to
protect the reputation and privacy of their employees and the institution.2
The Ohio State University Medical Center now has Social Media Participation
Guidelines which outline rules that employees are expected to follow when using
social media sites. These rules prohibit using social media sites during work
hours, using of a work email address on social media sites, and attributing any
opinions or comments posted on a website to the institution.2

This then begs the question of how e-professionalism should be taught
and when it should be introduced to professional students. Many universities
already incorporate a professionalism course or module in their curricula.Spending some time discussing e-professionalism
would be a relatively seamless addition to these courses. Kaczmarczyk and
colleagues recommend focusing on instruction regarding about e-professionalism
and how it reflects professional values, ethics, and integrity. Educators can
develop course materials that give students examples of what is acceptable
online behavior and behaviors to avoid.2 Instructors should have
students to evaluate online posts, discuss aspects of professionalism with
peers, and reflect on how postings may be interpreted by outside viewers.2It is also important that the institution’s
honor codes and policies include e-professionalism too.1

Although there are limited data regarding best practice approaches to
incorporating e-professionalism into the professional school curricula, there are
many examples of how to effectively teach the general principles of
professional behavior that could be applied.3 One example described
in the literature comes from Auburn University’s Harrison School of Pharmacy
(AUHSOP). This school promotes the development of professional behaviors from
admission to graduation. New students
and recently hired faculty go through orientation to learn about the school’s
culture as well as the values and expectations regarding professionalism and
integrity. Professionalism behaviors are evaluated and acceptable performance
is required for academic progression.Severe professionalism lapses can lead to student dismissal. This
curricular design instills the culture of professionalism and integrity at the
very beginning of the students’ academic career.Hopefully these behaviors and values continue
beyond graduation.

I believe that incorporating e-professionalism instruction throughout
the curriculum would be the most effective strategy for changing students’ perceptions
and practices. New student orientation would be an ideal time to introduce the
concept. Educators could discuss the importance of maintaining a professional
online persona and conduct a workshop in which students evaluate social media
profiles.This would make the
instruction more practical and relevant. To reinforce what was taught in orientation, there
could be an online module reviewing e-professionalism principles that students
are required to complete annually. Finally, given that potential employers or
residency directors may utilize social media websites when screening
candidates, e-professionalism should be explored again a few months prior
graduation.

Ness and colleagues conducted a study in which a survey was
distributed to graduating pharmacy students at several Midwestern schools of
pharmacy.4 A vast major (93%) of the pharmacy students used social
media websites.More importantly, 74%
felt that they should edit their social media profiles before applying for jobs.
Thus the prevalence of social media use is high among professional students and
students understand the importance of censoring publically available information
in order to portray a professional persona.

While social media and online communication is increasingly common,
educating students about professionalism and role modeling appropriate behavior
is not a new idea. Educators (and preceptors) should provide instruction on e-professionalism
and online etiquette to help prepare the next generation of professional
students for a successful career.

February 14, 2014

In
higher education, writing assignments often serve very broad academic purposes,
namely: to assess critical thinking, understanding, and memory.1As a writer, I’ve come to appreciate that
teaching about writing is too often overlooked. The writing skills I obtained
from my elementary school days through pharmacy school are used every day -
whether it is to write a short story or a SOAP note. Teaching proper writing methods
is critical not only because these skills are needed for high-level
professional positions but once improper techniques become ingrained, making
changes becomes more difficult. As the reader of numerous essays and residency
application letters, I’ve grown to appreciate the power writing – how it can
help some people achieve their aspirations and devastate others. Teachers can
prevent poor writing by teaching the process from a systematic and analytical
perspective. However many professionals claim the training they received during
their undergraduate years did not provide enough preparation for their on-the-job
writing tasks.2

Writing
workshops that teach teachers how to teach writing help them make better
instructional design choices, improve their own writing skills, and increase
their personal desire to write.3When teachers model the fundamentals of the
writing process such as pre-writing, drafting, and editing, students emulate
these tasks and begin to embed them into their own writing process.3
Incorporating writing assignments into a discipline specific context is the
best way to engage students and making writing assignments more relevant. For
example, pharmacy residency preceptors should assign writing assignments to
residents during most rotations.4

Audience
analysis is an essential component of writing.This guides the student towards creating a precise message that will be understood
by the audience based on the reader’s needs and objectives.5For example, when writing research grants, it’s
important to appeal to the reader in terms of how the study will advance the
funding organization’s mission. In this scenario, teaching students to role-play
reading the proposal as a member of the foundation’s board will enhance the
writer’s ability to align their needs with those of the organization.6

Assessing
writing and providing personalized feedback is crucial.Teachers need to reinforce proper writing
habits. Commenting on the content of a student’s written work has to be done in
the context of a student’s ability to understand the subject matter.1
For example, asking a resident to explain the rationale for the use of a drug
requires the preceptor to assess the resident’s comprehension of the existing
body of literature and to provide feedback in terms of the resident’s existing
knowledge. Peer review can help writers by providing a method of detecting common
errors in writing including simple grammatical and spelling mistakes.7

In
healthcare education, reflective writing assignments have become commonplace.These types of writing assignments are
intended to improve healthcare professional communication and patient
interactions.8 However many students lack proper writing skills and
thus fail to bring forth insight or meaning from their experiences.9

Checklists
which provide guidance and prompt the students to address specific questions is
one technique for improving writing skills. A checklist is a way for students
to prevent mechanical errors and to redirect students when there is a ‘stream
of ideas’.10A checklist can
include items specific to a task, however most will include items such as:9

oProper
use of Declarative, Interrogative, Imperative and Exclamatory Statements

oReference
list formatting

Modeling
good writing habits and helping students to understand the intended audience
are just two of the many methods to support students as they improve their writing skills.
Teaching writing should always include constructive feedback and checklists can
help students examine their own work.

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